Lateral Transmalleolar Approach and Miniscrews Fixation for Displaced Posterolateral Fragments of Posterior Malleolus Fractures in Adults: A Consecutive Study

Objectives: To evaluate the lateral transmalleolar (LTM) approach for a displaced posterolateral fragments of a posterior malleolus fracture. Design: Prospective, consecutive. Setting: Level 1 trauma center. Patients: Thirty-six patients. Outcome Measures: The x-rays, evaluation of arthritic changes of the ankle joint, range of motion, and Short Musculoskeletal Function Assessment questionnaire (SMFA). Intervention: The LTM approach followed by multiple interfragmentary miniscrew-only fixation. Results: No patients experienced intraoperative or postoperative complications that required a revision operation. All fractures healed. There were no infections, and no patient required implant removal. The median range of motion showed no significant difference as compared with the uninjured side. Patients achieved a mean SMFA dysfunction index of 8.2 +/- 2.4 points and a mean SMFA bother index of 3.2 +/- 1.2 points. All patients performed normal daily life activities at averagely 3 (range, 2-5) months postoperatively. Conclusions: Direct visualization with the LTM approach followed by fixation with multiple miniscrews may be an alternative option for the treatment of ankle fractures with a posterolateral fragment associated with a posterior malleolar fracture.